Accountable Care Organizations

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Summer Roundup: Antitrust Agencies Continue Scrutiny of Healthcare Markets and Attain Much Needed Victories

This summer, the Federal Trade Commission (“FTC”) and U.S. Department of Justice (“DOJ”) (together “antitrust agencies” or “agencies”) continued to push boundaries on what constitutes anticompetitive conduct with the withdrawal of key healthcare policy statements and heightened scrutiny of the pharmaceutical industry. This summer also saw the DOJ and FTC score crucial enforcement wins in … Continue Reading

The U.S. Department of Justice Signals Policy Change with Withdrawal of Three Healthcare Policy Guidelines

The U.S. Department of Justice (“DOJ”) recently withdrew three policy statements regarding conduct in the healthcare sector.  The statements withdrawn are the Department of Justice and FTC Antitrust Enforcement Policy Statements in the Health Care Area (dated September 1993); the Statement of Antitrust Enforcement Policy in Health Care (dated August 1996); and the Statement of … Continue Reading

The Next Generation ACO — The Yellow Brick Road to Capitation

The Centers for Medicare & Medicaid Services (CMS) recently announced its Better, Smarter, Healthier initiative, part of which plans on tying “30 percent of traditional, or fee-for-service, Medicare payments to quality or value through alternative payment models, such as Accountable Care Organizations (ACOs) or bundled payment arrangements by the end of 2016, and tying 50 percent of … Continue Reading

Board Members Should Heed OIG Compliance Guidance

Board members for organizations of all sizes need to be familiar with the OIG’s recent publication of Practical Guidance for Health Care Governing Boards on Compliance Oversight. This informative guide is intended to assist the Board member of any health care organization fulfil compliance obligations with the myriad of health care laws and regulations.  Although … Continue Reading

HHS Releases "Rate Review" Impact Data: Policyholders Save $1.2 Billion Nationwide

Last Thursday, September 12, 2013, the Department of Health and Human Services (“HHS”) reported that the rate review provisions (the “Rate Review Provisions”) of the Affordable Care Act (“ACA”) saved an estimated $1.2 billion on health insurance premiums in 2012 for 6.8 million policyholders.  The Rate Review Provisions are intended to increase transparency behind premium … Continue Reading

Proposed Rules Issued Extending Protections of Electronic Health Record Donations

Proposed Rules Issued Extending Protections of Electronic Health Record Donations On April 10, 2013, the Department of Health and Human Services (DHHS), Office of Inspector General (OIG) and the DHHS, Centers for Medicare & Medicaid Services (CMS) each issued a proposed rule relating to the donation of interoperable electronic health records software or information technology … Continue Reading

Two Squire Sanders Attorneys Offer Modern Healthcare Readers Insight on the Antitrust and Fraud and Abuse Implications of the New ACO Final Rule

Squire Sanders attorneys, Chris Gordon, a Principal in the Washington, D.C. office, and Rob Nauman, a Senior Associate in the Columbus, Ohio office, were recently interviewed by Modern Healthcare for their take on the relaxation of the interim final rule on waivers of fraud and abuse laws and the antitrust policy statement on ACOs.  Their … Continue Reading

ACO Webinar Reminder: Today at 2:00 P.M. (EDT)

Today at 2:00 P.M. (EDT), please join Squire Sanders and Strategic Health Care for our complimentary webinar overview of the final rule recently released by the Centers for Medicare & Medicaid Services (CMS) and the opportunities it presents for Accountable Care Organizations (ACOs). Speakers will include our own John Kirsner and Peter Pavarini as well as … Continue Reading

What Others are Saying: Media Round-Up on Final ACO Regs

This post has been contributed by Chase Matson, Manager, Government Relations, AMDR When we published last week’s blog post, Medicare ACO Rules Near Final Hurdle, we knew it would only be a matter of time before CMS released its final ACO regulations. Sure enough, only two days later, CMS officially published their long-anticipated rules, ending … Continue Reading

Webinar: Implications of the New ACO Regulations Announced for November 3

On Thursday, November 3rd, please join Squire, Sanders & Dempsey and Strategic Health Care for a complimentary webinar overview of the final rule recently released by the Centers for Medicare & Medicaid Services (CMS) and the opportunities it presents for Accountable Care Organizations (ACOs). As reported by the Accountable Care Forum, CMS made significant changes in … Continue Reading

Final ACO Antitrust Policy Released

On October 20, 2011, the Department of Justice and Federal Trade Commission jointly issued their “Final Statement of Antitrust Enforcement Policy Regarding Accountable Care Organizations Participating in the Medical Shared Savings Program.”  The policy statement, which largely mirrors the agencies’ proposed policy statement issued on April 19, 2011, outlines how the agencies will enforce U.S. … Continue Reading

Interim Final ACO Fraud and Abuse Waiver Rules and final ACO Antitrust Policy Statements Released

Concurrently with the release of the final rule for accountable care organizations participating in the Medicare Shared Savings Program (“MSSP”), the Centers for Medicare and Medicaid Services (“CMS”) and the Department of Health and Human Services, Office of Inspector General (“OIG”) released an interim final rule with a comment period addressing waivers of certain fraud … Continue Reading

CMS Releases MSSP/ACO Final Rule

On October 20, 2011, the Centers for Medicare and Medicaid Services (“CMS”) released the nearly 700-page, final rule for payments to health care providers and suppliers participating in accountable care organizations (“ACOs”) under the Medicare Shared Savings Program (“MSSP”).  In response to approximately 1,320 public comments to the proposed rule, the final rule makes a number … Continue Reading

Majority of Healthcare Executives Likely to Join an ACO

By Daniel J. Vukelich, AMDR Many healthcare executives may still be on the fence about the future impact of accountable care organizations (ACOs), but most of them still believe their institutions will ultimately join an ACO, according to FierceHealthcare‘s report on the results of a survey released by U.S. News and Fidelity Investments earlier this week.  According … Continue Reading

ACO Week in Review

Despite entering the Dog Days of Summer, ACO developments continue to unfold in a flurry.  The week started with The New York Times’ Robert Pear reporting that HHS will be hiring consultants to serve as secret healthcare shoppers, to check wait times for primary care physicians.  Clearly not well received, that plan was reversed just two … Continue Reading

AMA Comments Take Issue with ACO Regulations

The American Medical Association (AMA) recently issued its comments to CMS relating to the proposed Medicare Shared Savings Program ACO regulations.  The comments cover numerous areas of the proposed regulations, and overall, the AMA makes clear its concern that the program as currently proposed provides insufficient incentives for physician participation.  While acknowledging that the ACO … Continue Reading

Answers to a Few Frequently Asked ACO Questions

By Daniel J. Vukelich, AMDR Earlier this week, HealthLeaders Media addressed the Top 10 Clinical Integration, ACO Physician Questions.  Noting that physicians may be skeptical of new ACO arrangements, want to know how ACOs will impact their patients, and frankly how doctors will get compensated, the authors list the top ten most frequently asked questions about clinical integration (CI) and … Continue Reading

John Erikson Presents to Michigan Hospital Association

I recently co-presented a session regarding ACO’s with Tony Colarossi of Plante Moran.  We presented to the Michigan Hospital Association Excellence in Governance Fellows.  The audience consisted of hospital board members who participate in the fellowship program.  The board members were from hospitals large and small. The audience was keenly interested in the topic and … Continue Reading

Modern Healthcare turns to Squire Sanders Attorney as Expert Source on Proposed ACO Waiver Policy

We already know our John Kirsner as a frequent speaker and blogger regarding how CMS’ Accountable Care Organization regulations would impact health care delivery. Seeing Modern Healthcare’s Joe Carlson recognize him as such is further affirmation that Squire, Sanders, & Dempsey is building on its well deserved reputation as thought leaders in the future of … Continue Reading

Fierce Healthcare's Hospital Informer Profiles How Reprocessed Medical Devices Could Save Health Systems Billions

We love seeing our bloggers gain recognition.  Today, Dan Vukelich, blogger and President/CEO of the Association of Medical Device Reprocessors offers an insightful bylined news article that headlines today’s Hospital Informer, a Fierce Healthcare news outlet distributed to 15,000 hospital management subscribers.  The article offers an understanding of how the FDA-approved practice of third party reprocessing for certain … Continue Reading

Washington Post Reports on Results of Five Year Test of ACO-Like Incentives: Test Shows Innovation and Improved Care While Cost Savings Not as Significant as Hoped

The results from the five year “Group Practice Demonstration” project, which incentivized ten leading health systems if they could reduce costs by “treating older patients more efficiently while providing high-quality care,” were reported June 1 in the Washington Post. Although the article acknowledges that the test does not completely reflect the blueprint for ACOs eventually offered by CMS, … Continue Reading

Questions Arise Regarding Provider Participation in ACOs

At a recent briefing on ACOs, sponsored by Alliance for Health Reform and The Commonwealth Fund, a senior CMS official acknowledged what many in the provider community have been grumbling since the ACO proposed rules were released in March that the ACO program, as currently projected, sets too high a bar for participation and provides insufficient rewards … Continue Reading